Part B - Overview
This articles provides an overview of Medicare Part B (medical insurance), including coverage, costs and enrollment periods.
PART B (Medical Insurance) - Overview
Part B (medical insurance) provides for outpatient care, doctors’ services, laboratory tests and X-rays, durable medical equipment, and rehabilitative services such as physical therapy, occupational therapy, and speech-language pathology services. It also covers several preventive services.
There is a long list of services and products you are eligible for if you are enrolled in Part B. If you or your spouse are still working and have equivalent group health coverage at the workplace, you can delay your enrollment. In case you do not have equivalent health coverage from other sources, it is advisable that you enroll in Part B during the Initial Enrollment Period (IEP). Any delays in enrollment may result in permanent and substantial late penalties (10 percent of premium per year of delay).
Part B coverage includes doctor and specialist visits, outpatient treatment, preventive services, emergency ambulance services, laboratory tests and X-rays, mental health services, durable medical equipment and rehabilitative services.
However, there are many health services and products which are excluded from coverage such as acupuncture, chiropractic care and custodial care. This topic has been covered in another article titled 'What is NOT covered by Medicare?'.
Out-of-pocket Costs (during 2019)
Unlike Part A, everyone who enrolls has to pay a monthly premium for Part B.
If you are enrolling in Part B for the first time during 2019, you will have to pay $135.50 (the standard Part B monthly premium) or higher (upto $460.50), depending on your income. You need to pay this premium even if you enroll in a Medicare Advantage Plan (Part C) which provides Part A and Part B benefits. Many of those who were paying a lower-than-standard premium will continue paying a lower premium.
Once you meet your yearly deductible ($185 in 2019), Medicare typically provides for 80 percent of the approved amount for covered services while you pay the remaining 20 percent as coinsurance as well as any other costs.
Enrollment and Signup
You can enroll in Part B during initial enrollment period, special enrollment period or general enrollment periods. Depending on the situation you are in, it may be advisable to enroll in Part B as soon as possible to ensure that you have adequate medical coverage and to avoid any late enrollment penalties.
Initial Enrollment Period (IEP). You can enroll in Part B during the 7-month period that begins three months before the month you turn 65 and ends three months after.
If you sign up for Part A and/or Part B during the first three months of the IEP, your coverage will typically start the first day of your birthday month. If you enroll in Part A and/or Part B the month you turn 65, or during the last three months of the Initial Enrollment Period, the start date of your Medicare coverage may be delayed by one to three months.
Special Enrollment Period (SEP). If you delayed enrolling in Part B because you or your spouse were still employed and had a group health plan, you could enroll anytime while you are still covered by that group health plan or during the 8-month SEP after the employment ends or the coverage ends, whichever happens first.
General Enrollment Period (GEP). You can also enroll in Part A and/or Part B between January 1st and March 31st of each year, called the GEP. Your coverage won't start until July 1st of that year, and you may have to pay applicable late enrollment penalties.
Annual Election Period (AEP). If you are already enrolled in Medicare, this is the time when you can change your Medicare health or prescription drug coverage plans. You may also switch between Medicare Part A/Part B and Medicare Advantage (Part C) or make other changes. The AEP runs from October 15th through December 7th of every year for coverage beginning January 1st of the following year.
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Durable Medical Equipment
Part B - Coverage details